NPIMap

Organization Active NPI

Lifeway Pharmacy, LLC

  • Pharmacist
  • Monroe, LA
National Provider Identifier
1396015103
Registry record updated Jan 10, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
017373 Issued in LA
Legal business name
LIFEWAY PHARMACY, LLC
Practice address
1822 Tower Dr
Monroe, LA 71201-4938
Phone
(318) 323-5483
Fax
(318) 323-5485
NPI assigned
Jan 10, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Erica Sullivan Ditta, PHARMD
Title
Owner/Pharmacist in Charge
Phone
(318) 355-3202

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PharmacistGroup: 193400000X SINGLE SPECIALTY GROUP 183500000X 017373 LA Primary

Addresses

Primary practice location

1822 Tower Dr
Monroe, LA 71201-4938

Mailing address

1822 Tower Dr
Monroe, LA 71201-4938
Phone (318) 323-5483

National Provider Directory

National Provider Directory

Locations

1822 Tower Dr
Monroe, LA 71201
Phone (318) 323-5483

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1326153600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1326153600000",
    "number": "1396015103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1822 TOWER DR",
            "city": "MONROE",
            "state": "LA",
            "postal_code": "712014938",
            "telephone_number": "318-323-5483",
            "fax_number": "318-323-5485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1822 TOWER DR",
            "city": "MONROE",
            "state": "LA",
            "postal_code": "712014938",
            "telephone_number": "318-323-5483",
            "fax_number": "318-323-5485"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFEWAY PHARMACY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-10",
        "last_updated": "2012-01-10",
        "status": "A",
        "authorized_official_last_name": "DITTA",
        "authorized_official_first_name": "ERICA",
        "authorized_official_middle_name": "SULLIVAN",
        "authorized_official_title_or_position": "OWNER/PHARMACIST IN CHARGE",
        "authorized_official_telephone_number": "318-355-3202",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pharmacist",
            "state": "LA",
            "license": "017373",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Monroe, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.